NUR 355 Exam 4 MedSurg 1

NUR 355 Exam 4 (MedSurg 1) Students also studied Save Med surge exam 1 379 terms bresteg43Preview Comprehensive IV Therapy & Neuro ...114 terms katherinecarcamo12 Preview gi homework 28 terms syohannes7Preview key po 24 terms abb PCO2 normal range (carbon dioxide) 80-100 What causes respiratory alkalosis?Hyperventilation, anxiety, nervousness, fever, and sepsis -Blowing off all the CO2 What is a cause of respiratory acidosis?Too many opioids (resp depression) -Patient is retaining CO2 S/S of Hypovalemia (FVD) Fluid volume deficit, tachycardia, flattened neck vein, -elevated H&H, BUN and Serum osmolarity Hypovalemic, pt getting out of bed, what should the nurse worry about?Orthostatic hypotension, have them move slowly/ sit on side of bed and dangle legs before standing What are some causes of hypovalemia? dehydration from: vomiting, diarrhea, perspiration What is a fluid that can be used to treat hypovalemia? (FVD) 0.9% normal saline (isotonic) If given too much volume, and pt becomes Hypervalemic, what symptoms would be present?JVD, pitting edema, swelling, wet/crackle lungs, SOB How to prevent fluid volume overload? monitor I&Os What is an assessment the nurse can use to determine stable fluid volume of a pt?Listen to their lungs What is a great tx for edema?Elevate extremities, use sling for scrotum if needed Why is it important to weigh pt everyday? Most accurate, non-invasive way of managing fluid status If a pt is hypovalemic, what is something the nurse must educate The importance of daily weight "Weigh yourself every morning" Who is at most risk for dehydration? Elderly pt who is cognitively impaired pts Pt is dehydrated, what are some labs that might show it?Elevated osmolarity, Sodium, Creatinine, H/H Only give fluids fast if?Ordered by the provider Hyponatremia range135-145

What is a common cause of hyponatremia?-Low-salt diet -Excessive diaphoresis -Decreased secretion of aldosterone If a patient's sodium level is at less then 128, what are they at risk for?Seizures, implement seizure precautions Would you give an NPO (or nausea and vomiting) pt D5W and 0.45% normal saline?No, give something higher What client must be assess for potential hyponatremia?A patient on NPO who is receiving intravenous D5W Hypernatremia rangeGreater than 145 How do you treat a patient that has hypernatremia?Restrict fluid and advise low sodium diet -Avoid corn chips Common causes of hypernatremia?-NPO -Excessive sodium-containing I.V. Fluids -Corticosteroids Hypocalcemia range8.2-10.5 What is a surgery that can cause hypocalcemia?Partial or complete Thyroidectomy S/S of hypocalcemia?Twitching/tremors, muscle spasms, anxiety, and tetany How to treat Hypercalcemia?IV Calcitonin and Biphosphate Calcium greater then 3.5, what may a pt have?Decreased deep tendon reflexes (Ca) A patient has a serum calcium level of 14 mg/dL. Which MD order should be implemented first?Connect the client to a cardiac monitor3 multiple choice options Potassium greater then 5, what may a pt have?Cardiac arryhtmias Pt comes in and potassium is 7, what is an immediate treatment?Insulin and dextrose -however, another alternative IV Calcium gluconate Which EKG changes would you see with a K+ >5.5-6.5

Remember: Tall "peaked T waves" for potassium that is high

Low potassium rangeless then 3.5 What question should be asked if a patient's potassium (K+) is 2.9 mEq/L?Do you take diuretics of laxatives If potassium is 3.5, can the nurse push potassium?No, must administer slowly Hypermagnesemia pt may have decreased deep tendon reflexes (Mg) Who is at most risk for low magnesium? Long-term alcohol abuse, malnutrition, diarrhea Hypochloremia (low chloride) can be cause by?

-normal: 97-107

Severe vomiting and diarrhea S/S of low chloride are?Irritability, hypertension, and tetany S/S of high chloride are?Hypotension, weakness, altered LOC, and Kussmauls When someone has stress incontinence they?Leak when coughing, laughing, sneezing, etc.

What must a nurse monitor in patient's who have incontinence?Skin intact -educate kegels BPH (benign prostatic hyperplasia) priority intervention?Assess and find our medical and medication Hx Anti-cholinergic meds do what to the bladder?Relax the muscle, so it is contraindicated in pts with BPH -Diphenhydramine Alphablockers cause what?Smooth muscles of the prostate to relax Enlargement of the prostate is common with aging, so the tx is watchful waiting and monitor how it affects daily life S/S of BPH?Interrupted and weak flow What procedure can be done for BPH?Turp -watch for infection post-op What age to get the HPV vaccine?15-26 What must be educated about HPV?High risk of developing cervical cancer -inform sexual partners, use condoms, inform PCP if you have change in vaginal discharge, don't use HPV creams if pregnant There are meds for ED (erectile dysfunction), what must be done before giving them?Cardiac workup, check if they are on nitrates Some risk factors of ED?smoking and alcohol -organic version, caused by meds/diabetes/hypertension Cervical cancer, pt needs?Annual pap-smear to detect cancer and HPV If dysplasia shows on cervix, pt needs? a colposcopy What is something that increased risk for bladder cancer?Smoking S/S of UTIDyuria, burning, pain, foul smelling urine How much water should the pt, with a UTI, be advised to drink/day?2-3L or 2,000-3,000mL If a UTI goes untreated, what can happen?It can develop acute pyelonephritis -it can go to kidneys How may acute pyelonephritis present? With confusion, agitation and foul odor How to determine a healthy scrotum? Darker skin color then rest of body Tx for syphilis Penicillin -If allergic give doxycycline Who is at risk for gonorrhea?Low socioeconomic, multiple sex partners, STIs already, and Hx of pelvic inflammatory disease S/S of chlamydia?Discharge, dysuria Can pt take estrogen while going through menopause?Yes, if affective in treating hot flashes but at increased risk for breast cancer If a patient has breast cancer what should they not take?Estrogen!!-due to black cohosh What are the hormones that regulate menstrual cycle?Estrogen, progesterone, Luteinizing hormone, and gonadotrophin release hormone

Affect of Aldosterone when on Renin- Angiotensin-Aldosterone System (RAAS)?Controls water in body, some medications inhibit aldosteorne and release, which can lead to hyponatremia What is difusionParticles moving from a higher concentration to lower What is happening with Hypotonic solutions?Shift water from intravascular space to intracellular What is an example of a hypotonic solutions?

0.45% sodium Isotonicwhen the concentration of two solutions is the same What is two examples of isotonic fluids?Lactated ringers and 0.9% normal saline -Best fluid for correcting dehydration, expands volume, and corrects hypertension hypertonic solution 3% Draws fluids out of cell and back into circulation -Draws fluids out of cell and back into circulation Normal specific gravity

1.005-1.030

-dehydrated pt will be elevated (above 1.030) Pt with renal failure, what would their labs look like?Elevated BUN and creatinine, liver enzymes, and potassium high

Assessment: LE peripheral edema (pitting)

How much I&O is normal?Should be equal 40-80mL/hour